Methotrexate is a drug used to treat rheumatoid arthritis [RA] and other inflammatory conditions. Nearly 60% of all rheumatoid arthritis patients are currently on or have been on methotrexate. Methotrexate is recommended as the first treatment for RA by the American College of Rheumatology. Methotrexate is taken ONCE A WEEK. You will choose a day of the week, for example Saturday. You will then take your methotrexate every Saturday. The pills are 2.5mg each and the usual dose is 3 to 10 pills. Follow your rheumatologist’s directions. Do not take more or less medicine than ordered. This medicine can be taken with or without food. You should also take 1mg of folate [folic acid] each day. Your rheumatologist will prescribe the folic acid. This will
help prevent side effects. Methotrexate can cause mouth ulcers in a few patients, in the beginning of treatment. This should go away with time. Another possible side effect is nausea and vomiting. Methotrexate can also cause hair thinning or hair loss. In rare cases some people may develop lung problems. Methotrexate can cause mild liver irritation. Please tell your doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice,
or liver disease. While on methotrexate you must limit yourself to 2 alcoholic beverages per week. Blood work will be done every 4-12 weeks to check your liver function. This blood work will also include a complete blood count [CBC] since methotrexate can also cause a decrease in blood counts. This blood work is very important. It allows the rheumatologist to make timely changes to your dose of methotrexate if there is ever problem. Methotrexate is known to cause birth
defects in the children of both men and women taking this drug. If you are pregnant, considering having a child, or nursing, discuss this with your rheumatologist before beginning this medication. You must use an effective form of birth control while taking methotrexate and for at least 3 months after the methotrexate is stopped. Your rheumatologist or nurse can give you additional guidance. When you are taking methotrexate, it is
very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements. Methotrexate can be taken with other medications. You should not take methotrexate while taking antibiotics containing trimethoprim-sulfa [Bactrim®, Sulfatrim®, etc…]. If you are prescribed one of these medications for an infection, do not take your methotrexate that week. Always call your health care provider if you have any questions or concerns.What is Methotrexate?
How do I take it?
What about side effects?
What about other medications?
What else should I
know?
Methotrexate for ectopic pregnancy
Care instructions
What is methotrexate?
Methotrexate is a type of medicine that stops cells from dividing. It can be used as a way [other than surgery] to treat a pregnancy that’s implanted outside the uterus [ectopic pregnancy]. It’s given by injection, and usually just 1 dose is given.
You will need to have blood tests to monitor the level of pregnancy hormone in your blood. The methotrexate will stop the pregnancy. The level of pregnancy hormone in your blood should decrease over 2 to 4 days. Based on your blood test results, your doctor will tell you if you need another injection of methotrexate.
What will happen after you get methotrexate?
After you get methotrexate, you may have:
- mild to moderate cramps or pain in the abdomen [belly]
- vaginal bleeding [like a period]
Your doctor will likely want you to have a blood test 2 to 3 times a week, for 2 to 3 weeks. This is to see if the methotrexate worked to stop the pregnancy.
What you need to know about this medicine
Side effects of methotrexate may include:
- nausea, vomiting, or both [for 24 hours]
- decreased appetite
- sores in the mouth
- headache
- feeling tired
- redness, swelling, or pain at the injection site
- having trouble sleeping
- diarrhea
- hair loss [rare]
How can you care for yourself at home?
If you have nausea, sip clear fluids like ginger ale or soup broth. Try to drink often and eat small amounts of dry, starchy food [like soda crackers or dry toast] every 15 minutes.
To help prevent mouth sores:
- gently brush your teeth at least 2 times a day with a soft toothbrush
- rinse your mouth well with club soda or water 4 times a day
- don’t eat hot or spicy foods
If you need to take pain medicine for symptoms like headache or cramping, you can take acetaminophen [Tylenol] or ibuprofen [Advil, Motrin]. For 2 days after getting methotrexate, it’s best to take acetaminophen. If the acetaminophen doesn’t help, you can take ibuprofen unless your doctor tells you not to or if you have kidney problems. If you have any questions about medicine, talk to your healthcare provider or pharmacist.
To help relax the muscles that cause cramping, you can use a hot water bottle or a heating pad. Make sure you put a cloth between your skin and the heat, so you don’t get a burn. Taking hot baths can also help.
When should you call for help?
Call 911 if you have:
- heavy vaginal bleeding [soaks more than 1 pad an hour] and you’ve fainted [or feel like you’re going to]
- swelling in the face, mouth, or tongue
- trouble breathing
Call your doctor or nurse call line [811 in most provinces or territories] now if you have:
- sudden very bad cramps or pain in your abdomen [belly]
- blood in your urine or stools [looks like black, sticky tar]
- burning when you pass urine
- yellow skin or the whites of your eyes look yellow
- a bad skin rash
- chills or fever or both [temperature over 38.5 °C]
- any bleeding or bruising that isn’t normal for you
- heavy vaginal bleeding [more than the heaviest period you’ve ever had]
- a sore throat or a cough
What you need to know when you get this medicine
You must not get pregnant for at least 3 months after having a methotrexate injection. If you’re sexually active, you will need to use a reliable method of birth control. Talk to your doctor or healthcare provider if you have questions about birth control.
Washing your hands with soap and water after you go to the bathroom is important. Methotrexate can make your immune system weaker, which means it’s harder for your body to fight infections.
After getting methotrexate, do not have:
- sex until your doctor tells you that the treatment worked
- more than 1 drink of alcohol per day for 1 week
After getting methotrexate, do not take:
- aspirin [ASA] for 2 days
- penicillin, tetracycline, or minocycline for 2 days
To see this information online and learn more, visit MyHealth.Alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_pregnancy_ectopic_methotrexate_inst.
For 24/7 nurse advice and general health information call Health Link at 811.
Current as of: May 5, 2022
Author: Emergency Medicine, Alberta Health Services
This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.